Thursday, January 2, 2014

Aging and Migraines


For many people, as we get older (and better) our headaches may improve too. Migraine headaches often become less severe and less frequent. The nausea, vomiting, light sensitivity and other symptoms may also lessen with age. Tension-type headache may continue unchanged if the individual has had it for much of his or her adult life.

Occasionally the headaches may change in character or an older person who never had a significant problem before will suddenly develop headaches. When this occurs, it is important to have the headaches evaluated to rule out any underlying health problems.

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Headaches and Migraines through the Life Cycle

The most common type of headache is the tension headache, which is related to tight muscles in your shoulders, neck, and jaw. Anyone can experience this type of headache.

Migraines, which are less common, are headaches accompanied by specific symptoms such as visual disturbances called auras, nausea, and sensitivity to light or noise. Only about 12 percent of children who get frequent headaches will continue to experience them into their adult years, but kids and teens with migraines can expect them to continue into adulthood.

“The typical person with a migraine is a woman who started experiencing migraines in her teens or early twenties,” Dr. Quiceno says. While women can have migraines throughout their adult lives, they tend to taper off with menopause, becoming less frequent and less severe. “We have many patients who had migraines and lost them at menopause,” says Quiceno.

A minority of women may experience the opposite, having their first migraine as they approach perimenopause and menopause. This is likely due to their bodies' unique reaction to the hormone shifts of menopause.

Men also get migraines, but women are two to three times more likely to get migraines than men, likely due to a link between migraines and hormones.

What is Migraine?

This is not ordinary headache. It’s severe, thumping headache, usually but not always on one side of the head, which is often preceded by flashing lights in the eyes, nausea or vomiting.

It’s thought migraine is caused by changes in the blood vessels inside the brain, triggered by a small change in the serotonin activity. There may also be symptoms elsewhere in the body, such as pins and needles, numbness or, more rarely, slight weakness in one part of the body, usually hands. This may then spread up the arm to involve the face.

A migraine can last anything from a few hours to a couple of days. It can make it impossible to carry on with your normal daily activities – instead you have to lie down in a quiet dark room until the awful pain goes away.

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How to Identify Migraine?

There are multiple ways to self-identify you are going to have migraine or you are in migraine conditions already, however you should use them as the preliminary guidance, while turning to professionals for the medical validation and diagnosing.

1. Aura. Some people with a migraine experience aura. The most common auras are visual, such as flickering lights, spots, or lines. "You may see a little jagged line...that will develop some cross hatches, and it might sort of move in a curved direction," Dr. Calhoun says. Auras typically last between five minutes and an hour, with a 60-minute "skip phase" before the headache pain sets in, she says.
2. Depression, irritability, or excitement. Mood changes can be a sign of migraines. "Some patients will feel very depressed or suddenly down for no reason," Dr. Calhoun says. "Others will feel very high." Dutch researchers recently reported a possible genetic link between depression and migraines, especially migraines with aura. Data presented at the American Academy of Neurology 2010 annual meeting suggests that moderate or severe depression increases the risk of episodic migraines becoming chronic.
3. Lack of restful sleep. Waking up tired or having trouble falling asleep are common problems in people with migraines. Studies have shown an association between lack of restorative sleep and the frequency and intensity of migraines. When migraines strike, it's tough to get a good night's sleep. "A lot of people will have insomnia as a result of their migraine," says Edmund Messina, MD, medical director of the Michigan Headache Clinic, in East Lansing. This inability to sleep can be the start of a vicious cycle, as research suggests that lack of sleep can also trigger migraines.
4. Stuffy nose or watery eyes. Some people with migraines have sinus symptoms, such as stuffy nose, clear nasal drainage, droopy eyelids, or tearing, Dr. Messina says. One large study found that, among people who complained of sinus headaches, nearly 90% were having migraines.
5. Cravings. Before a migraine attack occurs, some people crave certain foods. "A common craving is chocolate," Dr. Messina says.
6. Throbbing pain on one or both sides of the head. Pulsating pain is a classic sign of migraines. The throbbing is often felt on one side of the head. In an online survey of patients with migraines, the National Headache Foundation found that 50% "always" have throbbing on one side, while 34% say they "frequently" have this symptom.
7. Eye pain. Migraine pain often burrows behind the eye. People will blame it on eye strain and many will get their eyes checked, but that won't make their headaches any better, Dr. Messina says.
8. Neck pain. "A lot of people will say, 'My neck gets stiff and then I get a headache.' Well, it's probably the early stage of the migraine," Dr. Messina says. "Or after a migraine they'll get that neck symptom or they'll have throbbing pain at the back of their neck." In an online survey, the National Headache Foundation found 38% of migraine patients "always" have neck pain and 31% "frequently" have neck pain during migraine headaches.
9. Frequent urination. If you have to go a lot, it can mean a migraine is coming. It's one of the many symptoms people experience just before a migraine. These warning signs, also known as the prodome phase of a migraine, can arrive as little as an hour or as much as two days before the start of headache pain.
10. Yawning. Yawning a lot is another tip-off that a migraine is about to strike. Unlike regular "I'm tired" yawning, it may be excessive and occur every few minutes. In one 2006 study in the journal Cephalalgia, about 36% of migraine patients reported yawning was one of the signs of an impending migraine.
11. Numbness or tingling. Some people with migraines have sensory aura. They may have a temporary lack of sensation or a pins-and-needles feeling, typically on one side of the body, moving from the fingertips through the arm and across the face.
12. Nausea or vomiting. According to data from the American Migraine Study II, a mail survey of more than 3,700 people with migraines, 73% experience nausea and 29% have vomiting. A recent analysis of the National Headache Foundation's American Migraine Prevalence and Prevention study found people with frequent migraine-related nausea have more severe pain and more trouble getting relief from medication than migraine sufferers with little or no nausea.
13. Light, noise, or smells trigger or worsen pain. In the throes of a migraine attack, the migraine sufferer tends to seek refuge in a dark, quiet place. Bright lights and loud noises can trigger a migraine or intensify the pain. The same is true of certain odors.
14. Activity triggers or worsens pain. Routine activities such as walking or climbing stairs can make migraine pain worse. Some migraines are induced by exercise (running, weight-lifting) or exertion (sexual activity). People with exertion-induced headaches require a thorough workup to rule out underlying causes, such as a brain aneurysm.
15. Trouble speaking. Can't get the words out? Speech difficulties can be another sign that a migraine is on its way. "A lot of people with migraines will feel like they're blithering," Dr. Messina says. "It's a common description by patients." If you are experiencing speech problems for the first time, contact a doctor to make sure the problems are not related to a more serious issue, such as a stroke.
16. Weakness on one side of the body. When an arm goes limp, it can be a sign of a migraine. Some people experience muscle weakness on one side of the body before a migraine attack. This can also be a sign of a stroke, however, so consult a doctor to rule out any other causes.
17. Vertigo or double vision. One type of migraine, called a basilar-type migraine, can cause dizziness, double vision, or loss of vision. Some people with migraines may experience balance problems too. In a recent study, Dr. Calhoun and colleagues found a link between migraine intensity and dizziness or vertigo. The stronger the migraine, the more likely patients were to have these complaints.
18. Headache hangover. After the migraine passes, a person may feel like her body has been pummeled.
In a recent study, researchers interviewed migraine patients and found that they commonly experienced symptoms such as fatigue, trouble concentrating, weakness, dizziness, lightheadedness, and loss of energy during the post-migraine period.

Trigger Factors

There is true that each person is unique, however there are certain commonalities among the most potent trigger factors for the Migraine development. Just list a few.

1. Stress or even relaxation after periods of stress. Stress can include bright lights, loud noise, long-distance travel and extremes of weather.
2. Severe clinical conditions of anxiety or depression.
3. Trauma to the head or neck.
4. Food intolerance (cheese, chocolate, alcohol and citrus fruits).
5. Missed meals.
6. Sleep deprivation or excessive sleep.
7. Oral contraceptives and vasodilators may precipitate or exacerbate the condition.
8. Migraines tend to occur when hormone levels are changing rapidly, particularly estrogen or testosterone. Women often suffer just before a period. Thankfully, migraines become much less common after menopause.

As with migraine experienced at any age, it is always worth being aware of what may be triggering your migraines and taking steps to reduce your exposure to these triggers where possible. Trigger factors can change over time and new triggers may be discovered if your circumstances change. Stress and red wine may be implicated at times whereas neck and back problems, and other health conditions, may be more significant at other times.

If you visit a health professional for advice in managing your migraine, it is very useful to keep a migraine diary before the appointment and take this along. You can simply block out days in different colors to distinguish migraine days, other headache days and headache-free days. This helps to show the pattern of symptoms and is useful for your doctor. You can also use migraine diaries to identify trigger factors although this is not always easy. It is thought that people with migraine have a more than usually sensitive nervous system that reacts to factors to which you are sensitive. Almost any factor can trigger an attack in a person predisposed to migraine and the list of possible suspects can be long and confusing. However it is worth persevering as reducing your exposure to your personal trigger factors can mean you are less vulnerable to a migraine attack.

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Headache as Symptom

As we get older, the chance that headache may be a symptom of some other problem becomes a greater concern. Whenever a patient reports a more severe or changed headache pattern, the doctor should do a careful history and examination to rule out the possibility that the headaches are related to some underlying disease.

Suspicion is greater if the elderly individual has other symptoms suggestive of illness, such as fatigue or unexplained weight loss. There is a condition called temporal arteritis or giant cell arteritis that occurs more often in older persons (over age 55), in which the larger arteries of the head become inflamed.

Headache is often an early sign, with or without other symptoms such as joint pain, difficulty chewing, fever, blurred vision, weakness, and weight loss. Typically the headache is a continuous throbbing pain in the temples. If untreated, temporal arteritis can result in blindness and other serious complications. Fortunately, it responds well to treatment and is usually cured. Since early diagnosis is essential to preventing complications, you should see your doctor promptly if you develop throbbing temporal headaches accompanied by any of these other symptoms. Unexplained weakness or weight loss should always be brought to your physician’s attention.

The possibility that your headaches might be related to underlying disease should not make you fearful of seeing the doctor and "learning the truth." On the contrary, you may discover that your headaches arise from something so simple as poorly fitting dentures, which put pressure on the teeth and gums that can translate into pain in the head and sinus region.

Headache as Side Effect

Older individuals are more likely to taking drugs for other chronic disorders, and headache is a known side effect of many medications. If you have reason to believe a needed medication may be linked to an increase in headache frequency, you should contact your doctor. A reduction in dosage or change to a related medication can be tried to see if the headaches respond. For example, some medicines for high blood pressure may cause increased headache as a side effect, but others are effective in controlling both blood pressure and chronic headache. Do not stop your medication or skip doses without consulting your doctor.

Treatment for Migraine

Treatment of migraine may not be straightforward in older age. That may be due to taking a number of different medications or having more than one health condition.

Health professionals have less information to rely on when prescribing medication for migraine in older people. Drug trials are usually carried out on healthy young adults so often less is known about how a drug may work or react in a child or an older person. This can reduce the number of treatment options available. Your doctor will need to take into consideration any other health conditions you may have and medications you might already be taking.

Make sure that your doctor knows what medication you are currently taking, including over the counter treatments and herbal remedies, especially if you are starting new medication.

The likelihood of side effects from medication can increase during older age. Getting older involves several changes that together alter the responses to medicines. These include changes to the digestion, liver, kidneys and vascular system. As we get older we are more likely to experience side effects from drugs. The significance of a particular side effect can change. For example if a drug has a side effect of dizziness, this could be of more concern to a person who may also be at risk of falling, than another younger person for whom the same side effect may not be as serious.

Medication taken for other health problems can cause headaches as a side effect, and this is often an unrecognized cause of headaches in older people. Drugs with the potential to trigger headaches include those used to treat certain heart conditions. Some drugs used for high blood pressure can worsen headaches, but others, such as beta blockers, can treat both. Be aware also that drugs may interact causing unwanted side effects or reduced efficacy. If you find your headaches increasing and you take several different drugs for medical conditions other than headache, it is worth checking with your doctor or pharmacist whether these medicines are a possible cause of some of your headaches.

While in most cases there is just impossible to manage migraines without taking prescribed medications, there are still some steps you can do to prevent it or at least decrease its frequency and severity.

Simple but effecting tips:
* Eat regularly.
* Aim for a diet based on foods that release sugar slowly into the bloodstream.
* Tying a headband around the head is a practice that's been done since ancient times, and some people claim it works.
* Drink plenty of water every day.
* Ensure adequate magnesium intake.
* Check you have correct alignment in your neck.
* Contrast (hot and cold) showers can sometimes alleviate migraine pain. This treatment is most likely to work as a preemptive measure. 

And here are the natural medicine recommendations:
* To relieve spasm of vessels take magnesium supplements 360mg a day, or 200mg twice a day  if you have migraines regularly.
* Omega Fish Oils reduce the amount of inflammatory substances that have been implicated in headaches.
* Evening Primrose Oil and alpha-linolenic acid (found in flax seed oil) supplements reduce the frequency, duration and severity of migraine attacks by 86%.
* Ginger may be effective in reducing symptoms of nausea during an attack.
* Ginkgo biloba and peppermint are believed to help stimulate blood supply to the brain.
* Chamomile tea has distressing properties, which may help ward off migraines.
* There is some evidence that the herbs feverfew and butterbur may prevent migraines or reduce their severity.
* A high dose of riboflavin (vitamin B-2) also may prevent migraines by correcting tiny deficiencies in the brain cells.
* Coenzyme Q10 supplements may decrease the frequency of migraines, but they have little effect on the severity of the headaches.
* Take melatonin. In a recent study, two-thirds of study participants who took melatonin before going to bed every night for 3 months said the number of migraines they experienced dropped by 50%.
* Try cannabis. Smoking cannabis ("marijuana") is the most effective method for numbing both nausea and the pain. It is the fastest method of obtaining relief, and it is widely recommended by practitioners. Some have reported success after smoking salvia divinorum during migraines, but research on the plant is very lacking. It is, however, much more readily available than cannabis.

There are also alternative therapies which may be helpful if you have chronic migraine pain:
* Massage. Massage stimulates our naturally occurring pain relievers called endorphins. When doing it yourself, try different parts of the head, however, it is recommended to visit the professional, specialized on the therapeutic massages.
* Acupuncture. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points. Clinical trials have found that acupuncture may be helpful for headache pain.
* Biofeedback. Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.
* Manual therapy. Massage and chiropractic treatments may help reduce the frequency of migraines. And it can improve the quality of your sleep, which can, in turn, help prevent migraine attacks.
* Aromatherapy. Peppermint, sandalwood, basil, lavender, eucalyptus, and rosemary essential oils can be used to treat migraines. Lavender and peppermint are the most highly recommended. One way to treat a migraine is to put 5 to 10 drops of lavender  or peppermint essential oil in a cup of warm water, soak a wash cloth in the water, wring it out, and apply it to the head or the back of the neck. Another method is to dilute a few drops of lavender or peppermint oil into a carrier oil (almond oil is a good choice) and massage it into the head at the back of the neck, the temples, and the forehead.

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